Ultima epistola?

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11 Anni 8 Mesi fa #200392 da glacial
Risposta da glacial al topic Re:Ultima epistola?
nel frattempo che aspettiamo l'eco addome io chiederei pure amilasi e dermoreazione di mantoux

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11 Anni 8 Mesi fa #200397 da ILBecchino
Risposta da ILBecchino al topic Re:Ultima epistola?
Carissima non ho letto bene il caso ma vedendo l'rx penso che abbia metastatizzato.

criptorchidismo---->seminoma ( associato spesso al criptorchidismo)
>mts.

Prima di scavare una fossa, prepara bene il terreno.
Prima di seppelire un Cadavere accertati della sua morte. Prima di chiudere il cancello del cimitero controlla che siano usciti tutti....... i visitatori non i defunti

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11 Anni 8 Mesi fa #200398 da HelterSkelter
Risposta da HelterSkelter al topic Re:Ultima epistola?
allora abbiamo già delle ipotesi diagnostiche valide:

1) seminoma, del magister, con cui concordo perchè ho letto anche io questa associazione tra criptorchidismo e tumore, con mts

2)glacial , tbc

io ci metto il Wegener

mmm ma ne mancano altre due per fare la diagnosi differenziale....

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11 Anni 8 Mesi fa #200399 da HelterSkelter
Risposta da HelterSkelter al topic Re:Ultima epistola?
ecco qua

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11 Anni 8 Mesi fa #200400 da HelterSkelter
Risposta da HelterSkelter al topic Re:Ultima epistola?

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11 Anni 8 Mesi fa #200401 da HelterSkelter
Risposta da HelterSkelter al topic Re:Ultima epistola?
il magister ha indovinato la diagnosi

Your Colleagues Responded:

Pulmonary sarcoidosis   10%
Bilateral round pneumonias   5%
Metastatic testicular cancer Correct Answer 69%
Wegener granulomatosis   16%

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11 Anni 8 Mesi fa #200402 da HelterSkelter
Risposta da HelterSkelter al topic Re:Ultima epistola?
The patient&#039;s chest x-ray showed bilateral lung masses of varying sizes, including multiple "cannon ball" lesions. In the left lung, there was a laterally located 9 × 6 cm mass, in addition to a 7-cm mass in the left lung base; a 7.5-cm mass was seen in the right lung. After the patient&#039;s chest x-ray was reviewed, metastatic cancer was considered because of the nature of the lesions. A more thorough physical examination was done, and the patient was found to have a firm, nontender mass in the left testicle. An ultrasound of the testicles was performed and was noted to demonstrate a 4.4 × 4.8 × 2.6 cm heterogeneous lobulated mass in the left testicle, with areas of flow to some portions and lack of flow to other portions (see Figures 2 and 3). This mass was highly suggestive of testicular cancer. There was also extensive associated microlithiasis and a small hydrocele in the affected testicle. Further laboratory testing revealed elevated serum tumor markers; the beta-hCG (human chorionic gonadotropin) level was 6992 mIU/mL (normal range, < 5 mIU/mL), and the AFP (alpha-fetoprotein) level was 1789 ng/mL (normal range, 0-20 ng/mL). A diagnosis of testicular cancer with lung metastases was established.

Testicular cancer is a rapidly progressive cancer that, despite being a rare condition and accounting for only 1% of all types of malignancies in men, is still the most common solid tumor in men aged 15 to 35 years. Testicular cancer must always be considered in any adolescent, young adult, or middle-aged man who presents with a testicular mass. Other risk factors for testicular cancer are family history, gonadal dysgenesis, Klinefelter syndrome, Down syndrome, or a history of cryptorchidism. Orchiopexy does not prevent the occurrence of cancer, but it facilitates diagnosis by allowing the surgically descended testes to be palpated and assessed for masses. It has been noted that patients who receive orchiopexy after 12 years of age have a higher relative risk of testicular cancer than those with corrective surgery at an earlier age.[6] Men with a history of testicular cancer have an increased risk of cancer in the other testicle up to 25 years after diagnosis. Infertility may be linked with testicular cancer; most men at the time of diagnosis have an abnormal semen analysis.[2,4]

The most common presentation in patients with testicular cancer is a painless lump felt in the testicle by the man or his partner. Unilateral testicular enlargement can also be a sign of testicular cancer. The patient may have nonspecific back pain at initial presentation caused by retroperitoneal lymphadenopathy; if lung metastases have developed, the patient may present with complaints of dyspnea or hemoptysis. Other signs and symptoms, such as testicular redness, swelling, discomfort, and pain, can occur as well. Testicular conditions, such as epididymitis, hematocele, or varicocele, have been noted to have a similar presentation as testicular cancer.[4]

An ultrasound examination of the testicles is the diagnostic modality of choice, and it can characterize the lesion and specifically identify the presence of a mass. If the clinical course, history, and symptoms (eg, acute onset, sexual history, fever, chills, nausea) are suggestive of orchitis, a trial of antibiotics (ie, focused on sexually transmitted diseases, such as ceftriaxone and azithromycin, for patients < 35 years of age; focused on enteric organisms, such as fluoroquinolone, for patients > 35 years of age) can be attempted, with a plan for close follow-up to assess for resolution of symptoms or the need for additional work-up. Testicular masses that are suspicious for cancer need to be further evaluated with a testicular ultrasound and serum tumor markers (beta-hCG, LDH, AFP), which will be elevated in the setting of testicular cancer. If an ultrasound examination and tumor markers suggest cancer, then an orchiectomy is indicated, with subsequent histopathologic evaluation. Cases that are ambiguous or cannot otherwise be resolved by ultrasonography may require a magnetic resonance imaging (MRI) scan for further evaluation. A computed tomography (CT) scan of the chest, abdomen, and pelvis is also recommended (especially if dyspnea or back pain is present) to investigate for metastases and for staging of the disease. Serum tumor markers are helpful because they can also disclose cancers that are too small to detect on the physical examination. Serum tumor markers are not only essential for diagnosis but also for prognosis and assessment of disease response to chemotherapy. The presence of high levels of serum tumor markers represents an increased likelihood for metastatic disease and a poor prognosis. These tumor marker levels should decrease with therapy; failure to do so usually indicates a resistance to therapy. Similarly, a resurgence of these markers can signify relapse of cancer after cessation of treatment.[4,5]

Testicular cancers are almost always germ cell tumors; other types of cancers, such as lymphoma, Leydig cell carcinoma, and Sertoli cell carcinoma, are very rare. Germ cell tumors are further categorized into seminomas and nonseminomas. Germ cell tumors that consist of only seminomas are called pure seminomas; nonseminomas consist of embryonal carcinomas, yolk sac tumors (also called endodermal sinus tumors), choriocarcinomas, and teratomas. Mixed germ cell tumors can contain any combination of nonseminomas and seminomas; however, if a tumor has a portion of any of the nonseminomatous cell lines in it, it is considered a nonseminoma because the nonseminomatous component most accurately reflects the response to treatment and overall prognosis. Different tumor markers are associated with different types of testicular cancers. The presence of high serum AFP levels is not usually seen in pure seminomas. Serum beta-hCG can be elevated in both seminomas and nonseminomas. Tumors with seminoma in the histopathology and an elevated AFP should be treated as nonseminomas.[4]

The prognosis of most testicular cancers is excellent, even when metastatic disease is present. The para-aortic lymph nodes are the initial site of metastasis. Patients with CT scans that are negative for lymphadenopathy have a 25-30% chance of having microscopic involvement of the lymph nodes. Nonseminomatous germ cell tumors are more likely than seminomas to spread hematogenously; the most common sites of hematogenous spread are the lungs, liver, and brain, as well as the para-aortic lymph nodes. Teratomas are the most benign form of nonseminoma, and they are the least likely to metastasize. Choriocarcinomas, which are the least differentiated, are most likely to metastasize. All other nonseminomas have an intermediate likelihood for metastasis.[2-4]

The standard treatment for most nonseminomas is orchiectomy and chemotherapy with bleomycin, etoposide, and cisplatin. Nonseminomas vary in prognosis depending on the sites involved and the tumor marker levels at diagnosis; 56-61% of nonseminomas have a good prognosis, with a 5-year survival rate of 92-94%. Even nonseminomas considered to have a poor prognosis, which account for 16-26% of tumors, have a 5-year survival rate of 71%. Most seminomas are treated with orchiectomy and radiation therapy. Seminomas have an overall better prognosis and are more sensitive to radiation therapy than nonseminomas. Patients with seminomas are never categorized as having poor prognoses. Seminomas that are diagnosed in the early stages have an almost 100% cure rate, and seminomas of any stage have a > 90% cure rate.[2,4,5]


Since the majority of tumors recur in the first 2 years after treatment, it is recommended that follow-up with serum markers and chest x-rays be performed monthly during the first year after treatment and every other month during the second year. Intermittent surveillance with abdominal CT scans should be done for up to 2-3 years after treatment. There are some reported cases of later relapse; lifelong periodic physical, radiologic, and laboratory examinations for these patients would be sensible.[4]

After this patient was admitted to the hospital for further evaluation, he underwent an orchiectomy of his left testicle. Histopathology demonstrated a stage III nonseminomatous testicular cancer, specifically a mixed germ cell tumor consisting of embryonal carcinoma and yolk sac tumor. There was extensive necrosis and lymphovascular invasion of cancer within the left testicle. The CT scan of the abdomen showed significant retroperitoneal lymphadenopathy that was likely causing his back pain. The patient was treated with multiple cycles of bleomycin, etoposide, and cisplatin chemotherapy. After treatment, a repeat chest radiograph (see Figure 4) and CT scan (not available) demonstrated near-complete resolution of his lung metastases and no residual retroperitoneal lymphadenopathy. At the follow-up examination, the patient&#039;s serum tumor markers were noted to have improved, with an AFP of 6 ng/mL (normal range, 0-20 ng/mL), a beta-hCG of < 2 mIU/mL (normal range, < 5 mIU/mL), and an LDH of 151 units/L (normal range, 98-192 units/L).

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11 Anni 8 Mesi fa #200405 da HelterSkelter
Risposta da HelterSkelter al topic Re:Ultima epistola?
magister nuovo caso?
:scenic:

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11 Anni 7 Mesi fa #200723 da DottorD
Risposta da DottorD al topic Re:Ultima epistola?
Sarebbe bello trovare un nuovo caso nell&#039;uovo di Pasqua!

"Even a stopped clock is right twice a day" (Marie von Ebner-Eschenbach)
Sir 26, 14

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11 Anni 7 Mesi fa #200727 da HelterSkelter
Risposta da HelterSkelter al topic Re:Ultima epistola?
già---peccato che ci ha abbandonato  :sorry:

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